Formulary Cost Research Articles

Budget Impact Analysis of Tapentadol Extended Release for the Treatment of Moderate to Severe Chronic Noncancer Pain

BackgroundOpioids are commonly used to manage chronic pain. Although traditional μ-opioids are effective in reducing pain, they are often associated with opioid-induced side effects (OISEs) that can limit treatment effectiveness. Studies have shown that tapentadol extended release (ER) has a lower incidence of gastrointestinal adverse events than oxycodone controlled release (CR) at equianalgesic doses. ObjectiveA model was developed to estimate the budget impact of placing tapentadol ER on a hypothetical US health plan formulary of Schedule II long-acting opioids. MethodsWe estimated annual direct health care costs for patients who received 6-month therapy with long-acting formulations of tapentadol, oxycodone, morphine, hydromorphone, oxymorphone, or fentanyl. Costs included medications, copayments, OISE management, and switching/discontinuation. Published estimates of incidence/prevalence, OISEs, and pain management resources and costs were used. The base case analysis assumed a 10% formulary share of tapentadol ER with a 10% decrease of oxycodone CR. The resulting per-member per-month (PMPM) formulary cost differences and results of a 1-way sensitivity analysis are reported. ResultsIn a health plan of 500,000 members, 2600 (0.52%) are estimated to experience chronic pain annually. Adding tapentadol ER to the formulary was associated with an annual budget savings of $148,945 ($0.0248 PMPM). This savings was achieved through a decrease in both pharmacy costs ($144,062; $0.0240 PMPM) and medical costs ($4883; $0.0008 PMPM). Cost decreases were driven by lower daily average consumption and fewer OISEs with tapentadol ER versus oxycodone CR, leading to reduced resource utilization over 6 months of treatment. Sensitivity analyses showed results were most sensitive to drug acquisition costs. ConclusionsOur results suggest that replacing 10% of oxycodone CR's formulary share with tapentadol ER would decrease the overall budget of a health plan with 500,000 members. Placing tapentadol ER on a health plan formulary may result in a reduction in both pharmacy and medical costs.

Chen, colleagues provide MTM in L.A.’s most vulnerable neighborhoods

Chen, colleagues provide MTM in L.A.’s most vulnerable neighborhoods

Successful Experience Utilizing Dexrazoxane Treatment for an Anthracycline Extravasation

To describe a successful case of dexrazoxane treatment after an extravasation of doxorubicin and share a creative solution for formulary cost management. A 42-year-old female diagnosed with breast cancer was receiving doxorubicin as adjuvant treatment. The patient recently underwent a right mastectomy for a 3-centimeter grade 3 invasive ductal carcinoma. Three of 20 lymph nodes were positive, and the patient was stage 2B at presentation, with an estrogen receptor/progesterone receptor-positive and HER-2/neu-negative tumor. At an outside hospital, the patient was receiving doxorubicin through an infusion port when extravasation was noted after approximately 15 mL had been infused. She was transferred to Riverside Methodist Hospital and dexrazoxane treatment was initiated within 6 hours after extravasation. She received a full 3-day course of dexrazoxane treatment without complication and was discharged home. Significant delays in chemotherapy administration were avoided, and the patient successfully completed her planned chemotherapy course. Dexrazoxane has the potential to minimize tissue damage and treatment delays after an anthracycline extravasation. Although dexrazoxane is commercially marketed for 2 separate treatment indications, Totect is the Food and Drug Administration-approved product for anthracycline extravasations. Facilities administering anthracyclines should proactively resolve how to obtain, process, prepare, and administer this antidote to a patient within 6 hours of an extravasation event. Developing a preprinted chemotherapy extravasation order may facilitate the incorporation of the most recent Oncology Nursing Society guidelines to utilize dexrazoxane for an anthracycline extravasation. Cost sharing with other institutions may offer a creative solution to lessen the financial impact of stocking dexrazoxane therapy. Ensuring expedient treatment and accessibility to dexrazoxane therapy after an anthracycline extravasation is critical to the success of the treatment. All facilities utilizing anthracycline chemotherapy should purchase dexrazoxane or secure agreements with other facilities to guarantee the administration of this medication should extravasation occur.

Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm

Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm

Assessing the impact of wastage on pediatric vaccine immunization formulary costs using a vaccine selection algorithm

Pediatric immunization is an important factor in providing protection against numerous common preventable diseases. The success of the pharmaceutical industry in developing new pediatric vaccines has resulted in a crowded recommended immunization schedule requiring several clinic visits over the first 12 years of life. Operations research models have been developed and used to make economically sound procurement choices from among a growing number of competing vaccine products. One factor that has not been incorporated into such models is the economic impact of wastage on such decisions. This paper reports results obtained from a vaccine selection algorithm that incorporates vaccine wastage data. The lowest overall cost formularies comparing no wastage costs with wastage costs are presented. A sensitivity analysis of the vaccine formulary with respect to the wastage rates associated with each available vaccine is provided. The maximum permissible wastage rate for each vaccine is determined for which the vaccine earns a place in the lowest overall cost formulary. This research provides health maintenance organizations and healthcare providers information that can be used to gain a better understanding of wastage and its impact on pediatric formulary costs.

Kosteneffektivität von rekombinantem FSH (r-hFSH) bei assistierten Reproduktionstechniken (ART) in Deutschland - Modellierung im Vergleich zu urinärem FSH (u-hFSH)

Ziel der vorliegenden Untersuchung war es, Wirksamkeit, Kosten und Kosteneffektivität einer Stimulation mit rekombinantem follikelstimulierendem Hormon (r-hFSH) und urinärem FSH (u-hFSH) bei assistierten Reproduktionstechniken zu vergleichen. Als Erfolg war eine fortlaufende Schwangerschaft ab der zwölften Woche definiert.

A Predictive Cost Analysis Model for Estimating Formulary Impact of New Products in Managed Care

Competition among new pharmaceutical products for unrestricted formulary inclusion continues to dominate the concerns of managed care decision makers. These competitive pressures may originate when a formulary appears to be overcrowded and underfunded based on what it is expected to deliver-primarily financial management of an ever-increasing list of new products in addition to day-to-day pharmaceutical needs. For those managers facing the daunting task of improving quality of pharmaceutical care with finite resources, appropriate product selection has become a dual consideration involving assessment of the new product's competitive clinical features and benefits, in tandem with an assessment of its formulary cost impact. We present a simple and objective financial model that, based on historical utilization data, will help predict a priori an accurate estimate of the cost impact of a new product. We illustrate our financial model with a new calcium antagonist (CA), T-Block. T-Block is the first of a new generation of nondihydropyridine, T-channel selective CAs entering a crowded therapeutic area for the treatment of hypertension and angina pectoris. This model compares the weighted average cost-per-prescription for CAs before and after the formulary inclusion of T-Block. Three key variables of the model-utilization ratios of available strengths, market share for the new product, and annual CA prescription volume-facilitate preparation of customized financial analyses. Accordingly, the model's simple three-way sensitivity analysis defines specific financial scenarios under various conditions of uncertainty. The model also can be used as a post-formulary utilization management and market share tracking tool.